Innføring av vaginalpinne som diagnostisk test

Tema/ problemstilling: Klamydia er en svært vanlig seksuelt overførbar infeksjon (SOI). I skandinaviske studier anslås prevalensen å være 1- 8 %. Hos kvinner er 60-80 % av klamydia tilfellende asymptomatiske. Klamydia er en viktig årsak til ekstrauterine graviditeter, infertilitet og barnløshet, og til kroniske bekkenplager. Det finnes tre diagnostiske tester for genital klamydiainfeksjon: urinprøve, cervix prøve og vaginalpinne. Dette kvalitetsforbedringsprosjektet går ut på å finne den optimale diagnostiske testen for klamydia hos kvinner. Det kartlegges hva som skal til for å implementere tiltaket ved et kontaktet legekontor. Kunnskapsgrunnlag: Her ble søkemotoren McMaster pluss brukt med følgende PICO spørsmål: ”chlamydia diagnostic test sensitivity”. I tillegg ble norske retningslinjer hentet fra norsk elektronisk legehåndbok og hjemmesidene til Helsedirektoratet og Folkehelseinstituttet. Alle retningslinjer anbefaler analyse av prøvematerialet ved hjelp av NAAT-teknikk. Prøvematerialet kan være fra cervix, vagina eller urin. UpToDate, Norsk elektronisk legehåndbok og Health Protectition Agency anbefaler bruk av vaginalpinne som diagnostisk metode. BestPractice og Helsedirektoratet skiller ikke mellom test ved første urinporsjon og vaginalpinne. Spesifisiteten var 98% for alle tre testene. Gjennomgående hadde vaginalpinne høyest sensitivitet, men konfidensintervallene overlappet. Tiltak/kvalitetsindikator: Tiltaket for prosjektet er å endre diagnostisk test for genital klamydiainfeksjon hos kvinner fra første urinporsjon til vaginalpinne på et legekontor. Prosjektets hovedkvalitetsindikator er en prosessindikator: andel vaginalpinner av innsendte klamydiaprøver fra kvinner. I tillegg kan strukturindikator med fokus på tilgjengelig utstyr og kompetanseutvikling benyttes. Resultatindikator i form av færre komplikasjoner ble vurdert, men er mer anvendelig i større studier og lenger tids oppfølging. Dagens praksis: I dette prosjektet ble det opprettet et samarbeid med et fastlegekontor på østlandet. Ved fastlegekontoret tas alle pasienter som testes for klamydia inn til konsultasjon. Under 10 pasienter tester for klamydia i halvåret. Kvinner med symptomer undersøkes ved en gynekologisk undersøkelse og asymptomatiske kvinner leverer urinprøve før konsultasjon. Prosess, ledelse og organisasjon: Langley og Nolans PUKK-sirkel brukes som et praktisk verktøy i dette forbedringsarbeidet. En av legesekretærene er ansvarlig for implementering av tiltaket og tilgjengelighet av utstyr og informasjon. Fastlegen har det overordnede faglige ansvar, ved å følge med på endringer av retningslinjer. Alle ansatte ved legekontoret og pasientene som testes bør kjenne til riktig prøvetakning ved klamydia. For å kontrollere at tiltaket er implementert registreres andel innsendte vaginalpinner hver 6. måned. Basert på gjennomføringsgraden og hvordan tiltaket fungerer i praksisen, foretas det en korrigering. Konklusjon: Litteraturen gir ikke entydig svar på hvilken diagnostisk test som bør benyttes ved mistenkt genital klamydiainfeksjon. Konfidensintervallene for testenes sensitivitet er overlappende, men punktestimatet for vaginalpinne ligger høyere enn for de to andre. Vaginalpinne har i tillegg det smaleste konfidensintervallet. Da legekontoret tester under ti kvinner i halvåret vil tiltaket ha konsekvenser for få kvinner, men viktig for å unngå falsk negativ svar hos den enkelte kvinne. Prosjektet konkluderer med at tiltaket er gjennomførbart og bør implementeres i praksis

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Effekt av medfødt hypothyreose på hjerneutvikling

Abstract Congenital hypothyroidism may cause stunted physical and mental growth (cretinism). In the western world this is prevented by neonatal screening combined with hormonal substitution of affected individuals, but the condition is still common in non-western regions where maternal nutritional deficiency of iodine occurs. Even though the screening program is a success, some studies do suggest that motor and cognitive abilities may be lower than normal in children treated for congenital hypothyroidism. This may indicate that low levels of thyroid hormones prior to birth may have permanent effects on the brain. We have tested whether hypothyreodism induced by Methimazole treatment disturbs the rates of mitosis and apoptosis of cerebellar granule neurones in the chicken embryo. Eggs were injected with three different concentrations of Methimazole or control NaCL on embryonic day (ED) 16 and sacrificed on ED 17 when the mitotic and apoptotic rate peaks in cerebellar granule neurones. We found a tendency that some doses of Methimazole reduced the mitotic rate while no increase in apoptotic rate was detected. We propse that larger scaled experiments should be performed in order to obtain statistically significant results

Search for direct top squark pair production in final states with two leptons in s=13\sqrt{s} = 13 TeV pppp collisions with the ATLAS detector

International audienceThe results of a search for direct pair production of top squarks in events with two opposite-charge leptons (electrons or muons) are reported, using $36.1~\hbox {fb}^{-1}$ of integrated luminosity from proton–proton collisions at $\sqrt{s}=13$ TeV collected by the ATLAS detector at the Large Hadron Collider. To cover a range of mass differences between the top squark $\tilde{t}$ and lighter supersymmetric particles, four possible decay modes of the top squark are targeted with dedicated selections: the decay $\tilde{t} \rightarrow b \tilde{\chi }_{1}^{\pm }$ into a b-quark and the lightest chargino with $\tilde{\chi }_{1}^{\pm } \rightarrow W \tilde{\chi }_{1}^{0}$ , the decay $\tilde{t} \rightarrow t \tilde{\chi }_{1}^{0}$ into an on-shell top quark and the lightest neutralino, the three-body decay $\tilde{t} \rightarrow b W \tilde{\chi }_{1}^{0}$ and the four-body decay $\tilde{t} \rightarrow b \ell \nu \tilde{\chi }_{1}^{0}$ . No significant excess of events is observed above the Standard Model background for any selection, and limits on top squarks are set as a function of the $\tilde{t}$ and $\tilde{\chi }_{1}^{0}$ masses. The results exclude at 95% confidence level $\tilde{t}$ masses up to about 720 GeV, extending the exclusion region of supersymmetric parameter space covered by previous searches

Measurements of ttˉt\bar{t} differential cross-sections of highly boosted top quarks decaying to all-hadronic final states in pppp collisions at s=13 \sqrt{s}=13\, TeV using the ATLAS detector

Measurements are made of differential cross-sections of highly boosted pair-produced top quarks as a function of top-quark and $t\bar{t}$ system kinematic observables using proton--proton collisions at a center-of-mass energy of $\sqrt{s} = 13$ TeV. The data set corresponds to an integrated luminosity of $36.1$ fb$^{-1}$, recorded in 2015 and 2016 with the ATLAS detector at the CERN Large Hadron Collider. Events with two large-radius jets in the final state, one with transverse momentum $p_{\rm T} > 500$ GeV and a second with $p_{\rm T}>350$ GeV, are used for the measurement. The top-quark candidates are separated from the multijet background using jet substructure information and association with a $b$-tagged jet. The measured spectra are corrected for detector effects to a particle-level fiducial phase space and a parton-level limited phase space, and are compared to several Monte Carlo simulations by means of calculated $\chi^2$ values. The cross-section for $t\bar{t}$ production in the fiducial phase-space region is $292 \pm 7 \ \rm{(stat)} \pm 76 \rm{(syst)}$ fb, to be compared to the theoretical prediction of $384 \pm 36$ fb

Study of the material of the ATLAS inner detector for Run 2 of the LHC

International audienceThe ATLAS inner detector comprises three different sub-detectors: the pixel detector, the silicon strip tracker, and the transition-radiation drift-tube tracker. The Insertable B-Layer, a new innermost pixel layer, was installed during the shutdown period in 2014, together with modifications to the layout of the cables and support structures of the existing pixel detector. The material in the inner detector is studied with several methods, using a low-luminosity √s=13 TeV pp collision sample corresponding to around 2.0 nb−1 collected in 2015 with the ATLAS experiment at the LHC. In this paper, the material within the innermost barrel region is studied using reconstructed hadronic interaction and photon conversion vertices. For the forward rapidity region, the material is probed by a measurement of the efficiency with which single tracks reconstructed from pixel detector hits alone can be extended with hits on the track in the strip layers. The results of these studies have been taken into account in an improved description of the material in the ATLAS inner detector simulation, resulting in a reduction in the uncertainties associated with the charged-particle reconstruction efficiency determined from simulation

Searches for the ZγZ\gamma decay mode of the Higgs boson and for new high-mass resonances in pppp collisions at s=13\sqrt{s} = 13 TeV with the ATLAS detector

International audienceThis article presents searches for the Zγ decay of the Higgs boson and for narrow high-mass resonances decaying to Zγ, exploiting Z boson decays to pairs of electrons or muons. The data analysis uses 36.1 fb$^{−1}$ of pp collisions at $\sqrt{s}=13$ recorded by the ATLAS detector at the CERN Large Hadron Collider. The data are found to be consistent with the expected Standard Model background. The observed (expected — assuming Standard Model pp → H → Zγ production and decay) upper limit on the production cross section times the branching ratio for pp → H → Zγ is 6.6. (5.2) times the Standard Model prediction at the 95% confidence level for a Higgs boson mass of 125.09 GeV. In addition, upper limits are set on the production cross section times the branching ratio as a function of the mass of a narrow resonance between 250 GeV and 2.4 TeV, assuming spin-0 resonances produced via gluon-gluon fusion, and spin-2 resonances produced via gluon-gluon or quark-antiquark initial states. For high-mass spin-0 resonances, the observed (expected) limits vary between 88 fb (61 fb) and 2.8 fb (2.7 fb) for the mass range from 250 GeV to 2.4 TeV at the 95% confidence level

Search for the dimuon decay of the Higgs boson in pppp collisions at s\sqrt{s} = 13 TeV with the ATLAS detector

International audienceA search for the dimuon decay of the Higgs boson was performed using data corresponding to an integrated luminosity of 36.1  fb-1 collected with the ATLAS detector in pp collisions at s=13  TeV at the Large Hadron Collider. No significant excess is observed above the expected background. The observed (expected) upper limit on the cross section times branching ratio is 3.0 (3.1) times the Standard Model prediction at the 95% confidence level for a Higgs boson mass of 125 GeV. When combined with the pp collision data at s=7  TeV and s=8  TeV, the observed (expected) upper limit is 2.8 (2.9) times the Standard Model prediction

Measurements of ttˉt\bar{t} differential cross-sections of highly boosted top quarks decaying to all-hadronic final states in pppp collisions at s=13 \sqrt{s}=13\, TeV using the ATLAS detector

Measurements are made of differential cross-sections of highly boosted pair-produced top quarks as a function of top-quark and $t\bar{t}$ system kinematic observables using proton--proton collisions at a center-of-mass energy of $\sqrt{s} = 13$ TeV. The data set corresponds to an integrated luminosity of $36.1$ fb$^{-1}$, recorded in 2015 and 2016 with the ATLAS detector at the CERN Large Hadron Collider. Events with two large-radius jets in the final state, one with transverse momentum $p_{\rm T} > 500$ GeV and a second with $p_{\rm T}>350$ GeV, are used for the measurement. The top-quark candidates are separated from the multijet background using jet substructure information and association with a $b$-tagged jet. The measured spectra are corrected for detector effects to a particle-level fiducial phase space and a parton-level limited phase space, and are compared to several Monte Carlo simulations by means of calculated $\chi^2$ values. The cross-section for $t\bar{t}$ production in the fiducial phase-space region is $292 \pm 7 \ \rm{(stat)} \pm 76 \rm{(syst)}$ fb, to be compared to the theoretical prediction of $384 \pm 36$ fb

Observation of WWW Production in pp Collisions at √s = 13 TeV with the ATLAS Detector

This Letter reports the observation of W W W production and a measurement of its cross section using 139     fb − 1 of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from W W W production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive W W W production cross section is measured to be 820 ± 100   ( stat ) ± 80   ( syst )     fb , approximately 2.6 standard deviations from the predicted cross section of 511 ± 18     fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy